Provider Demographics
NPI:1962284406
Name:BALDERSTON, SARA JEANNE (RD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:JEANNE
Last Name:BALDERSTON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:B
Other - Last Name:SWEEDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:713-410-7645
Mailing Address - Fax:
Practice Address - Street 1:2 ROSALIND LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-4202
Practice Address - Country:US
Practice Address - Phone:713-410-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2024-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87198133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered